Original articlePotential use of procalcitonin as biomarker for bacterial sepsis in patients with or without acute kidney injury
Introduction
Sepsis caused by bacteria is the major cause of death in intensive care unit (ICU) patients. Rapid initiation of the correct treatment is crucial important for improving sepsis condition [1], [2]. Additionally, the most recent international sepsis guidelines entitled “Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012” recommend early diagnosis and treatment of sepsis to avoid multiple organ failure and other adverse outcomes [3]. In treatment of sepsis antibiotics have already clear benefits, however potential complications from their inappropriate or prolonged using are also well known. Inappropriate or prolonged using of antibiotics lead to multidrug-resistant bacterial strains, allergic reactions, antibiotic-related colitis, and other adverse events [4], [5], [6]. From such situations it is emphasized that the early and accurate detection of sepsis are very important.
Since the definition of systemic inflammatory response syndrome (SIRS) was proposed by the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) in 1991 [7], many clinical trials on sepsis diagnosis and treatment have been conducted. And sepsis was defined when patients met the criteria for SIRS and an infectious source was documented or strongly suspected based on clinical presentation. Blood culture is frequently used as the “gold standard” diagnostic method for sepsis. However, it usually takes 3–7 days to obtain blood culture results and frequently yields low positive results or low sensitivity [8]. Therefore, the general practical medical treatment used for sepsis is based on the doctor's own experience (empiric therapy).
Many trials have identified potential biomarkers. More than 170 biomarkers have been studied for use in evaluation of sepsis [9]. In 1993, procalcitonin (PCT) was first described as a marker elevated in bacterial infections [10]. In infectious conditions, PCT is released from nearly all tissues including lung, liver, kidney, pancreas, spleen, colon, and adipose tissues [11]. Currently, PCT is recognized as one of the suitable markers for diagnosis of sepsis or severe sepsis. In comparison to other markers which have traditionally been reported, PCT gives a high rate of specificity for sepsis diagnosis [12]. However, the concentration of PCT in the human blood is elevated in various conditions, such as in severe trauma, surgical invasive procedures, and critical burn injury, which leads to SIRS. So it is necessary to be aware of false-positive results [13]. In addition, it has been reported that renal function is a major determinant of PCT levels and thus different thresholds should be applied according to renal function impairment [14]. To the best of our knowledge, there are few studies investigating the relationship between PCT and acute kidney injury (AKI). So, the purpose of this study is to clarify the accuracy of diagnosing sepsis using the PCT levels according to AKI severity.
Section snippets
Materials and methods
This is a retrospective study conducted at Fukuoka University Hospital, which is a 915-bed academic center with 34-bed ICU. The ICU has an average admission of about 800 patients per year. The ICU admissions typically include 60% outpatients (including those transferred from the emergency department), 30% transferred from other hospitals, and 10% in-house patients (not including post-operated and newborn patients). The ratio of adult and pediatric (<16 years) patients was 93:7. The study was
Enrolled patients
We have registered 2582 patients from June 2010 to May 2013, and we excluded 2189 according to the exclusion criteria. Thus, a total of 393 patients (225 men and 168 women) were included in this analysis (Fig. 1). The median age of the patients was 65 (53–76) years. Clinical diagnosis of patients is shown in Table 2. The number of sepsis patients is 110 (sepsis, n = 21; severe sepsis, n = 31; septic shock, n = 58). The microbiological examination results in sepsis patients are shown in Table 3.
Discussion
The most common causes of AKI in critically ill patients are sepsis [17]. So it is necessary that we need to diagnose sepsis in AKI patients the fastest way possible. Recently Mehanic et al. [18] reported that the PCT is a reliable marker that contributes to the early diagnosis of invasive bacterial infections and evaluation of their severity and prognosis. However, status of kidney or liver may contribute to PCT clearance from the plasma, and severe dysfunction of these organs could influence
Competing interests
The authors declare that they have no competing interests.
Acknowledgments
We sincerely thank Ms. Kanae Misumi of the Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University for her help in data encoding.
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